Lizzie Presser reports for Pro Publica on how the corporate for-profit health care system is rigged against Black Americans and puts shareholder interests ahead of patients’ care needs. Presser looks specifically at how Black Americans with chronic kidney disease are three to four times likelier to reach kidney failure than white Americans, even though they suffer from similar rates of disease.
Among other health inequities, Black Americans are twice as likely to develop diabetes than white Americans and that makes it more likely that their kids will have diabetes. Black Americans are also more likely to be uninsured or underinsured, and to struggle to pay for their medications. They are more likely to suffer from hypertension and diabetes, which are primary drivers of kidney disease. And, the formula for determining whether kidneys are functioning factors in race in a way that undermines Black Americans’ ability to get needed care.
You might not know it, but the US has Medicare for all with kidney failure. Everyone with kidney failure is eligible for Medicare. Medicare covers all the medically necessary care that people with kidney failure need.
Unfortunately, treating kidney failure has become a big for-profit business. DaVita and Fresenius are the two biggest corporate players with 70% of the market. And, their incentive is not to refer their patients for transplants. They profit the longer their patients remain on dialysis.
Put differently, if you go to a for-profit facility for dialysis, you are less likely to get on a waiting list for a transplant. The incentives are not there for the facility to make the referral. They lose patients and revenues with each person who gets a transplant.
But, dialysis facilities are the gateway to a kidney transplant. Patients tend to look to the people who care for them at these facilities for help getting referrals for transplants. Black patients fare worse than white patients.
Black Americans are 18 percent less likely to get care from a nephrologist in the year before getting dialysis, in part because they are less likely to be insured. As a consequence, one specialist says mortality rates are seven times higher for Black patients than white patients. If you have diabetes and do not have good access to specialty care, you are likely not to get drugs that can ward off kidney failure. You are more likely to go without a transplant.
Patients with kidney failure benefit greatly from kidney transplants. There are not enough living donors, so many people must rely on kidneys from people who have just died. Demand for kidneys far exceeds supply.
The Centers for Medicare and Medicaid Services (CMS) has laid out specific protocols for dialysis centers to notify their patients about transplant options. But providers like DaVita are not following guidelines, and CMS is not enforcing them. And, it does not track or publicize rates of referrals from different dialysis centers, nor does it penalize centers that have low referral rates. There are also no rules that ensure equal access to referrals and evaluations for patients. This must change.
Here’s more from Just Care:
- Medicare covers diabetes prevention program
- What are Medicare premium and other costs in 2021?
- Taking statins may increase risk of diabetes for some
- Screening criteria for diabetes and pre-diabetes
- Medicare coverage for people with diabetes
